12.07.11 9:45 AM ET

Amid the past month’s disturbing revelations about child sexual abuse at Penn State and Syracuse—and the debates over morality and complicity and punishment—it can be easy to forget that pedophilia is a mental illness, and that legally, it only becomes a crime when acted upon. Yet the key to preventing and treating the disorder may lie in its clinical details.

Among psychiatrists, views on pedophilia differ. Some researchers liken it to an addiction, others to sexual orientation; still others put their faith in brain scans. Yet pedophilia is consistent in the criteria that define it: erotic desire directed wholly or partially towards pre-pubescent children, typically under the age of thirteen. And for reasons not definitively established, there are undeniably more male than female pedophiles; by some estimates, men perpetrate as many as 94 percent of sexual offenses against children.

Studying the disorder is complicated by the fact that, in the U.S., laws that went into effect in the 1990s require therapists and physicians to report to child protective services (and other authorities that vary by state) anyone they believe poses a threat to a child. The legislation trumps patient-doctor confidentiality in these circumstances. Since reporting a potential pedophile results in legal action, the law has deterred many pedophiles from voluntarily seeking psychiatric help—which troubles some researchers, since the disorder can be easier to prevent than treat.

As a result, almost all research on pedophiles is based on convicted sex offenders—those who have already acted on their desires—most of whom are or have been in prison. As Judith Herman, a psychologist who works with abused children at the Victims of Violence clinic in Boston told The Daily Beast in an e-mail: “Truthfully, I don't think the psychiatric profession has much of a clue about pedophiles. Most studies are based on…the 5 percent who get caught—a very unrepresentative group.” In other words, most pedophilia research subjects are outliers.

Still, a small community of psychiatrists is working to better understand the disorder—work that could ultimately help to prevent the kind of suffering we’ve recently come to hear all too much about.

Fred Berlin, a psychiatrist and director of the sexual behavior unit at Johns Hopkins, is one of the country’s best known and respected researchers on pedophilia. In his view, knee-jerk moral condemnation is beside the point. “We don’t know why we experience the sexual desires that we do. For so long, we’ve looked at it as if it’s simply a moral issue—people are supposed to have certain attractions—and often society said if you experience a different kind of sexual temptation or feelings, you’re not as morally worthy a person,” he said. “It’s not someone’s fault they have the condition, but it is their responsibility to do something about it. Telling me that someone has pedophilia is like someone saying about me that I’m heterosexual. It doesn’t tell you whether I’m kind or cruel, introverted or extroverted, caring or not caring, intelligent or not intelligent.”

Berlin stresses the diversity of the pedophiles he’s worked with. “There are people with pedophilia that are often in denial, the way some alcoholics deny having a drinking problem,” he said. “There are some who believe that society should change, and that we shouldn’t insist that they not act on their attractions. In my experience, that’s been a minority. There are others who are desperately looking for help to try and make sure they stay in control, and many of them are very pleased to learn that there’s a medicine that might help.”

Indeed, one of the few treatments these patients can seek out is medication that lowers testosterone levels, to blunt the intensity of the erotic desire. Clinicians also sometimes prescribe anti-depressants, both to address co-existing psychiatric problems and for the common side effect of lowering sex drive. They also often recommend psychotherapy that involves cognitive-behavioral methods, to challenge patients’ skewed belief systems.

Judith Becker, a psychiatrist and professor at the University of Arizona—who has evaluated more than a thousand pedophiles—conducts this kind of therapy. She commonly asks her patients to consider how old they felt when they were engaging in sexual acts with kids. For some, she says, this question has been an “aha moment,” helping them realize that, in their involvement with children, they’ve actually regarded themselves as being of the same age as their victims. During these encounters, Becker said, it’s as if they slipped back to a much earlier phase in their own development—or perhaps never graduated beyond it in the first place.

Becker has also studied how this perception plays into the so-called “grooming” of victims widely reported in the media in the wake of the Penn State scandal. Pedophiles will often spend months insinuating themselves into a child’s life, taking them to ball games, showering toys and gifts on them and becoming a part of the child’s universe—to the point where a child can’t recognize that a clear transgression has occurred when the interaction turns sexual. Or if the child does feel uncomfortable, he or she may still feel entangled with the adult and fear losing the relationship.

Yet according to Becker, the elaborate process isn’t exclusively about the sexual gratification they expect to gain from the effort. The bonding itself is a source of satisfaction, since many pedophiles identify so strongly with children. During therapy, Becker will attempt to facilitate relationships between pedophiles and other adults, helping them gain the social skills they often lack.

Becker also points out that many pedophiles don’t operate with cold clarity about the ethics of what they’re doing. Instead, they weave “cognitive distortions,” absolving themselves of guilt or responsibility. For example, they might tell themselves, “The child didn’t say no when I started,” or “somebody did it to me when I was a child, and I thought it was okay for me to do it too,” or “I truly love the child.”

Mark Deantonio, a child and adolescent psychiatrist at UCLA, echoes friends and neighbors of pedophiles who stress how “normal” offenders can seem; how functional and unassuming. The erotic fixation on pre-pubescent children that defines pedophilia is "one area of horrible deviance in someone who can otherwise maintain a normal existence,” he said. Their sexual desires are completely “compartmentalized.”

Yet this doesn’t necessarily accord with the findings of James Cantor, an associate professor in the department of psychiatry at the University of Toronto, who is one of the few researchers in the world studying pedophilia from a biological perspective, searching for brain-based and other physical differences that distinguish pedophiles from non-pedophiles.

Notably, Cantor has found that, on average, pedophiles have an IQ that is 10 points lower than the average population, they are 2.5 centimeters shorter, and they are significantly more likely not to be right-handed (i.e., they’re left-handed or ambidextrous). Non-right handedness has been shown to occur more often among people with both autism and schizophrenia, two “clearly biologically based” psychiatric conditions.

Cantor’s most potentially consequential finding, however, is his most recent one, published in a 2008 study. Using brain-scanning technology, he discovered significant differences in the white matter—the substance that connects one brain region to another—of pedophile versus non-pedophile brains (both groups were composed of convicted criminals, to rule out the confounding variable of criminality). In the pedophile group, Cantor found significantly less white matter in two different regions, suggesting a connection deficit.

Cantor doesn’t shy away from talking about causality. “The brain has a network that’s responsible for detecting what in the environment is a potentially sexual object,” he said. “And when there’s not enough white matter, that network doesn’t function like it’s supposed to.” He theorizes that, due to abnormal functioning in these networks, the instinct that children provoke in pedophiles is erotic, rather than the typical urge to nurture and protect. He also believes that the finding is one more piece of evidence for the case that pedophilia is caused by a biological susceptibility that starts before birth.

Cantor believes that prevention, more than treatment, is the great hope for this disorder—and that “pinpointing the point when things go awry,” as he put it, could allow for intervention. He emphasizes what many outside the field might find difficult to accept: Pedophilia is “a medical condition, rather than a moral failing,” he said. “Nobody chooses to be a pedophile.”